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Clinical profile and outcomes of pediatric ependymoma: a 10-year retrospective analysis from a resource-limited
Farrah Bashir1, Nowal Hussain2,3, Bilal Mazhar Qureshi1
1Department of Oncology, Aga Khan University Hospital, Basement-2, IBN ZUHR Building, Karachi, Pakistan.
Insights
Pediatric ependymoma treatment in Pakistan showed a 10-year overall survival of 79.2%. Multimodal therapy achieved favorable outcomes despite resource limitations in this low- and middle-income country (LMIC) setting.
Area of Science:
- Pediatric neuro-oncology
- Central nervous system tumors
- Ependymoma research
Background:
- Pediatric ependymomas represent 6-10% of childhood CNS tumors.
- Limited survival data exists for LMICs, particularly South Asia.
- This study addresses the clinical profile and outcomes in Pakistan.
Purpose of the Study:
- Evaluate clinical characteristics of pediatric ependymoma.
- Assess treatment approaches and survival outcomes.
- Provide data from a tertiary care center in Pakistan.
Main Methods:
- Retrospective cohort study of 48 patients (0-21 years).
- Data collected on demographics, presentation, tumor characteristics, and treatment.
- Survival analysis using Kaplan-Meier estimates for OS and PFS.
Main Results:
- Median age 7.5 years; 64.6% male.
- Posterior fossa (50%) and spinal cord (20.8%) were common locations.
- 10-year OS rate was 79.2%, PFS rate was 66.7%; recurrence in 18.8%.
Conclusions:
- Multimodal treatment achieved favorable outcomes in an LMIC setting.
- Early diagnosis and individualized management are key.
- Findings highlight the importance of localized data for improving pediatric brain tumor care.
Background:
Pediatric ependymomas account for 6-10% of central nervous system tumors in children and are the third most common pediatric brain tumor. However, survival and outcome data from low- and middle-income countries (LMICs), particularly in South Asia, are limited. This study aims to evaluate the clinical profile, treatment approaches, and survival outcomes of pediatric patients with ependymoma in a tertiary care setting in Pakistan.
Methods:
This retrospective cohort study included 48 pediatric and young adult patients (aged 0-21 years) diagnosed with ependymoma and treated at Aga Khan University Hospital, Karachi, from January 2012 to December 2021. Data were collected on demographics, clinical presentation, tumor location, histopathology, treatment modalities, and follow-up. Survival analysis was conducted using SPSS version 23.0, with Kaplan-Meier estimates for overall survival (OS) and progression-free survival (PFS), and comparisons performed using the log-rank test.
Results:
Of the 48 patients, 64.6% were male, with a median age of 7.5 years. Presenting symptoms included headache and vomiting (43.75%), limb weakness (25%), back pain (20.83%), and ataxia (18.75%). Tumors were located in the posterior fossa (50%), supratentorial region (29.2%), and spinal cord (20.8%). All patients underwent surgical resection; postoperative complications were noted in a subset. Histopathological subtypes included anaplastic (62.5%), classic (33.3%), and myxopapillary ependymoma (4.2%). Adjuvant radiotherapy was given to 62.5% and chemotherapy to 10.4%. The 10-year overall survival (OS) and progression-free survival (PFS) rates were 79.2% and 66.7%, respectively. Tumor recurrence was observed in 18.8% of cases.
Conclusion:
Multimodal treatment yielded favorable outcomes despite resource constraints. Early diagnosis and individualized management are crucial for enhancing survival in low- and middle-income country (LMIC) settings.
